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PJP Prophylaxis in Non-HIV — SCE Infectious Diseases MCQ

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ModerateImmunocompromised HostPJP Prophylaxis in Non-HIVSCE Infectious Diseases

A 38-year-old woman with SLE on Mycophenolate and Prednisolone 10 mg develops Pneumocystis jirovecii pneumonia. After successful treatment, her rheumatologist asks whether her immunosuppressive regimen should be modified to reduce PJP risk. What is the most important intervention?

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Correct answer: A — Prescribe long-term Co-trimoxazole prophylaxis while immunosuppressive therapy continues

The key intervention is prophylaxis, not necessarily immunosuppression modification (which is dictated by SLE disease activity). Co-trimoxazole (480–960 mg daily) should be prescribed as secondary PJP prophylaxis for as long as significant immunosuppression continues. Primary PJP prophylaxis should be considered for all patients on significant immunosuppression — roughly equivalent to Prednisolone ≥20 mg/day for ≥1 month, or dual immunosuppressants. Azathioprine carries similar PJP risk to Mycophenolate.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections